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General NPI Number Information
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NPI Number | 1699264275
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Entity Type | Individual
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Provider Name | GHAZEL TELLAWI PHD
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Gender | Female
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Dates
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Enumeration Date | 05/09/2018
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Last Update Date | 08/27/2025
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Provider Practice Location Address
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Address Line | 1979 RICHMOND DR STE 1
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City | LOUISVILLE
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State | KY
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Zip | 40205-1411
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Country | US
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Telephone | 612-234-1834
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Fax |
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Provider Business Mailing Address
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Address Line | 1979 RICHMOND DR STE 1
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City | LOUISVILLE
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State | KY
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Zip | 40205-1411
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Country | US
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Telephone | 612-234-1834
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | LP6552
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 3854-57
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License Number State | WI
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 285496
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License Number State | KY
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